Testis & paratestis

Nonneoplastic lesions

Granulomatous orchitis

Last author update: 1 December 2012
Last staff update: 26 January 2021

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PubMed Search: Granulomatous orchitis [title] testicular

Sean R. Williamson, M.D.
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Cite this page: Williamson S. Granulomatous orchitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisgranulomatousorchitis.html. Accessed August 17th, 2022.
Definition / general
  • Rare; usually men 40 - 59 years with sudden onset of tender testicular mass, variable fever
  • May be a response to acid fast products of disintegrated sperm, postinfectious or due to trauma or sarcoidosis
  • Resembles pyogenic epididymo-orchitis
  • Benign, although granulomatous inflammation may be associated with seminoma
  • Recommend cultures to rule out infectious process (brucellosis, leprosy, sarcoidosis, syphilis, TB)
  • Granulomatous ischemic lesion:
    • Usually affects head of epididymis
    • May be due to ischemia with secondary granulomatous reaction and scarring
    • References: (Am J Surg Pathol 1997;21:951)
Gross description
  • Solid, unilateral nodular enlargement of testis; resembles lymphoma
Microscopic (histologic) description
  • Lymphocytes and plasma cells infiltrate interstitium and surround seminiferous tubules
  • Giant cells and histiocytes that resemble (but are not) actual granulomas
  • Granulomatous ischemic lesion:
    • Zone of necrosis involving efferent ducts and interstitial connective tissue, with adjacent lymphocytes and macrophages
    • Macrophages form large clusters with cholesterol crystals and foreign body type giant cells in duct lumen
    • Also intratubular epithelial regeneration and proliferation of small ducts showing epithelial regeneration and numerous spermatozoa in their lumen
    • Associated with ceroid granuloma, spermatic granuloma and epidermoid metaplasia of the efferent ducts
Differential diagnosis
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